Right minithoracotomy versus conventional median sternotomy for patients undergoing mitral valve surgery and Cox-maze IV ablation with entirely bipolar radiofrequency clamp

Abstract

Cox-maze IV ablation by bipolar radiofrequency clamp was considered to be only performed through median sternotomy (MS), but impossible through right minithoracotomy (RM). Now, we developed a novel technique of performing Cox-maze IV ablation entirely by bipolar clamp through RM. To compare the outcomes of RM or MS for patients undergoing mitral valve surgery and concomitant Cox-maze IV ablation with entirely bipolar clamp. All 152 patients underwent mitral valve surgery and concomitant Cox-maze IV ablation with bipolar clamp through RM (n = 69) or MS (n = 83) were analyzed for outcome differences. The etiology of mitral valve disease was rheumatic (n = 97) and degenerative (n = 55). All patients had long-standing persistent atrial fibrillation (AF). Diameter of left atrium ranged from 42 to 60 mm. All patients successfully underwent Cox-maze IV ablation by bipolar clamp. RM group had longer cardiopulmonary bypass time (130.3 ± 17.7 vs 115.3 ± 14.4 min; P < 0.001) and aortic cross-clamp time (91.8 ± 12.7 vs 74.6 ± 9.3 min; P < 0.001). But mechanical ventilation time (14.2 ± 6.6 vs 21.3 ± 9.0 h; P < 0.001) and hospital length of stay (9.3 ± 2.6 vs 11.7 ± 3.0 days; P < 0.001) were shorter in RM group. At discharge, the maintenance of normal sinus rhythm (NSR) was 94.2% in RM group and 95.1% in MS group (P = 1.000). Cumulative maintenance of NSR at 2 years postoperatively was 85.1 ± 5.8% in RM group and 88.6 ± 3.6% in MS group (P = 0.767). RM can achieve similar therapeutic effect to MS for patients undergoing mitral valve surgery and concomitant Cox-maze IV ablation with entirely bipolar clamp. In addition, patients through RM had faster recovery.

Minimally Invasive Mitral Valve Surgery With Concomitant Cox Maze Procedure Is as Effective as a Median Sternotomy With Decreased Morbidity

“…These findings were consistent with the 2 studies mentioned above. 16,17 Furthermore, the RMT cohort had less postoperative blood transfusions, a finding consistent with the Jiang et al study. 16 An interesting finding in our study was the difference in permanent PPM rate between the surgical approaches (18% MS vs 4% RMT).…”

“…16,17 Furthermore, the RMT cohort had less postoperative blood transfusions, a finding consistent with the Jiang et al study. 16 An interesting finding in our study was the difference in permanent PPM rate between the surgical approaches (18% MS vs 4% RMT). Although the overall PPM rate of 11% is comparable to previously reported rates in the literature for concomitant MV surgery and CMP-IV, 2,12,16,17,26,27 the PPM difference between these 2 surgical approaches has not been reported.…”

“…In a study by Jiang et al, 69 RMT and 83 MS patients who underwent MV surgery and concomitant CMP had no difference in NSR reported at 2 years (82% RMT vs 89% MS). 16 Similarly, in another study, RMT and MS patients who underwent concomitant CMP and MV surgery had no significant difference in the freedom from ATA recurrence at any time up to 2 years. 17 Both studies had limited follow-up and unmatched cohorts.…”

“…10,15 However, there are few data that compare the long-term rhythm outcomes, based on surgical approach, for patients undergoing concomitant surgical ablation and MV surgery. 16,17 Knowing the long-term outcomes after an RMT approach is critical because the RMT approach requires modification of both the ablation and surgical strategies. 18 The goal of our study was to examine both the long-term rhythm and survival outcomes, based on RMT versus MS surgical approach, in 116 propensity-matched pairs, all of whom underwent concomitant CMP-IV and MV surgery.…”

The occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation

“…The Cox-Maze procedure (MP) is a well-established method of rhythm control in patients with AF, which has shown similar efficacy in patients with AF associated with valvular disease, coronary disease, or congenital heart disease compared with that in patients with AF alone [ 2 – 4 ]. In recent years, bipolar radiofrequency ablation, also known as Cox-Maze IV procedure (CM-IV), is widely used in the surgical treatment of AF [ 5 – 7 ]. However, the development of symptomatic bradyarrhythmia is a major complication of Cox-Maze IV procedure, which can lead to fatal or necessitate pacemaker implantation.…”